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The steady increase in births by cesarean section in this country has led to a growing debate among medical experts over when surgical births are necessary and how many such deliveries are too many.

In 2008, the c-section rate in the eight-county Philadelphia region was 34 percent compared with 21 percent a decade earlier, according to an Inquirer analysis of state data. At some hospitals - Virtua Voorhees in South Jersey and at Doylestown and Lankenau hospitals in suburban Philadelphia - the c-section rates exceeded 40 percent.

A new study by researchers at the Christiana Health System in Delaware and Johns Hopkins University in Maryland found that when doctors use drugs to induce labor in women, the likelihood of a c-section delivery increases dramatically.

The researchers examined the deliveries of 7,804 women of whom, 43.6 percent were induced; and nearly 40 percent of those were induced at the mother's request. After adjusting for various risk factors, the women who were induced had nearly double rate of c-sections.

"Labor induction is significantly associated with a cesarean delivery at term for those with and without medical or obstetric complications," the researchers concluded. "Reducing the use of elective labor induction may lead to decreased rates of cesarean delivery for a population."

The study was published in the current issue of the journal Obstetrics & Gynecology.